Services Reviewed Using InterQual Criteria
This administrative guideline describes the services that Premera reviews for medical necessity using InterQual criteria and informs providers which services and settings are subject to those reviews. It applies to Company staff, providers, and members in the Individual market.
No material clinical or coverage changes in this revision.
Services Reviewed with InterQual Criteria
Acute Adult Modules
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.